AimTo evaluate the serum levels of sFas and sFasL in normotensive subjects with different degree of impairment of glucose tolerance as well as in type 2 diabetic patients with treated and treatment-naïve hypertension (AHT).Material and methods124 subjects (63 males and 61 females), of mean age 46,31±10,78 years are included in the study, divided in 5 age-matched groups: 19 subjects with type 2 diabetes (DM) and drug-controlled AHT; 30 subjects with type 2 DM and drug-naïve AHT; 30 normotensive subjects with type 2 DM; 26 normotensive subjects with prediabetes and 19 healthy controls. Serum sFas and sFasL levels are determined by highly sensitive enzyme immunoassay technique.ResultsNo significant differences in sFas are observed among the studied groups. The levels of sFasL are decreased in normotensive subjects with type 2 DM (p<0,05), while subjects with prediabetes have intermediate values. In both hypertensive groups with DM sFasL levels are further decreased.ConclusionsSerum sFas levels probably are not associated with the presence of impairment of glucose tolerance or AHT. Serum sFasL values tend to be decreased in subjects with impairment in glucose tolerance; further decrease is observed in hypertensive subjects with type 2 DM. Antihypertensive treatment does not influence the levels of sFasL.
BackgroundAlveolar soft part sarcoma (ASPS) is a rare diagnosis in the perianal region.Methodswe describe the clinical presentation, pathological findings and differential diagnosis of a rare case of perianal ASPS. We also describe the importance of the preoperative embolization of the hypervascularised masses to prevent surgical bleeding.Conclusionsclinical and pathological findings are essential for the diagnosis, specifically by immunochemistry and molecular techniques, as the demonstration of ASPL/TFE3 fusion transcript became indispensable in some cases. Preoperative embolization of the hypervascularised masses may prevent uncontrollable surgical bleeding.
We report the case of a 73 year old woman who presented for progressive dyspnea. Her medical history included thyroidectomy 15 years ago, myocardial infarction, recurrent paroxysmal atrial fibrillation and femoral fracture two weeks previously, conservatively treated. Physical examination revealed absent breath sounds in the left hemithorax, up to the apex, and crackles in the right hemithorax. The acid-base balance showed acute hypoxemic respiratory failure. The chest X-Ray revealed left diaphragmatic paralysis. Thoracic CT-scan was performed, which excluded the pulmonary embolism and revealed left diaphragmatic relaxation, ascension of the splenic angle of the colon, stomach and spleen up to the projection of left lung hilum, and right postero-basal alveolar condensation process. Diaphragm dysfunction can be caused by various disorders, including phrenic paralysis. This pathology should be considered in the differential diagnosis of acute respiratory failure.
Introduction Transradial (TR) approach for coronary and peripheral angiography has become a popular technique. The Allen’s test (AT) could be used to determine the presence of collateral flow in the hand. Recently, angiographic background of modified AT was evaluated, but patients with peripherial arterial disease (PAD) were excluded in these studies. Therefore, the present study was designed to assess reliability of AT in patients with symptomatic PAD. Methods The present study comprised 92 symptomatic patients with PAD (Rutherford class 2–6). Perfusion of the hand was assessed with AT before outpatient peripheral angiography. Results Significant RA stenosis (n=6, 12.5%) and UA stenosis (n=26, 54.2%) were found in 30 patients with positive AT (62.5%). In patients with negative AT, only UA showed significant stenoses (n=6, 13.6%). Thirty-eight patients with positive AT had anatomic abnormality in the forearm arteries or in the palmar arch (79.2%). Anatomic abnormality in the forearm arteries or in the palmar arch could be detected in 15 cases with negative AT (34.1%, p<0.0001). Conclusions. In the presence of an abnormal AT and concommitant PAD, the use of RA for peripheral or coronary catheterization and angioplasty is not recommended.
Rationale and objectivesGeneral practitioners (GPs) play an important role in management of patients at risk of osteoporosis (OP). The objectives were to assess (1) knowledge about OP and use of OP clinical guideline in comparison with other information sources and (2) association between the use of individual information sources and knowledge and self-reported quality of care among GPs.MethodsSurvey among random sample of Czech GPs was performed to find out their attitudes and role in OP management. The return rate of the postal questionnaire was 38% (525 respondents). Quality of care was assessed using three indicators: suspicion on OP, referral to the specialist and initial check-up.ResultsRespondents (median age 52 years, 59% women) had a very good knowledge of several risk factors, while others, namely low body mass index, history of hip fracture in mother and smoking were perceived as risk factors by only 40%, 45% and 55% of respondents, respectively. 10% of GPs stated the correct answer regarding daily calcium intake recommended for postmenopausal women. The OP guideline was considered accessible by 83% of respondents and used repeatedly by 54%. Use of the guideline correlated positively with knowledge score (P < 0.001), while use of each individual other source of information did not. Use of the guideline correlated with all three indicators of quality of care. Use of each other information source correlated only with a maximum of two indicators.ConclusionWe identified areas of insufficient knowledge that should be targeted in educational activities for GPs. It is recommended to further motivate GPs to use their clinical guidelines regularly.
We perform an update about nutritional measures that have been adopted in patients with acute pancreatitis (AP). The nutritional support is an essential part of treatment in AP. When the AP is mild or moderate, there is no doubt that is not necessary to use an artificial nutritional support, and it is recommended that oral nutritional support should begin as soon as possible. If the AP is severe, the best way to provide nutritional support is through enteral nutritional (EN) because it reduces infection, length of hospitalization and mortality rate. Parenteral nutrition (PN) should be used only when EN is Impossible. However, there is no scientific evidence for recommending the most optimal route necessary to administer this type of nutritional support; we seek to uncover whether this is by gastric or jejunal route and the proper formula to use. There is an international agreement that the nutritional support should begin quickly, within the first 24 and 72 hours of hospitalization. As conclusion, more research needs to be done concerning nutritional support in AP, and many questions are not been answered yet.
Venous thromboembolism (VTE) causes considerable morbidity and mortality. About half of all VTE cases in adults are related to recent hospitalization, in spite of the clinical guidelines regarding prophylaxis. We aimed to assess the frequency and the independent risk factors in VTE in hospitalized patients, and to compare the risk factors in medical versus surgical cases. A case-control study consisting of 732 patients (382 with VTE and 350 controls) was designed. At least one risk factor was found in 90.31% of VTE cases; more than half of the patients presented multiple risk factors, associated with a double risk comparatively to the intervention of only one factor. A similar distribution of the risk factors was found in both medical and surgical patients, except for congestive cardiac failure (predominant in medical cases) and respectively, varicose veins, previous episode of VTE and cancer (predominant in surgical VTE patients). The independent risk factors in VTE were the following: previous episode of VTE, obesity, chronic obstructive pulmonary disease, congestive cardiac failure, varicose veins and cancer. The study shows the importance of the risk factors in VTE and the need to detect hospitalized patients at risk in both medical and surgical cases.
A 53-year-old immigrant male patient presented with left scrotal swelling with a draining ulcer on the left hemiscrotum. Patient had intentional weight loss, fever and night sweats, cough, headaches, confusion and difficulty with ambulation. Imaging studies revealed innumerable pulmonary nodules, leptomeningeal enhancement of the brain and bilateral epididymo-orchitis. Acid fast bacilli (AFB) smear was positive from the surgical specimen of bilateral epididymis and left testes. Cerebrospinal fluid (CSF) analysis revealed neutrophilic predominant pleocytosis with low glucose and elevated protein. Polymerase chain reaction (PCR) test performed on the CSF and AFB smear of epididymis was positive for Mycobacterium tuberculosis. Though the CSF and sputum AFB smears were negative, cultures subsequently grew mycobacterium tuberculosis. Patient was diagnosed with disseminated tuberculosis. Human deficiency virus test was negative. Patient was successfully treated with anti-tuberculosis therapy. Steroid was used as adjuvant therapy due to presence of tuberculous meningitis.
Objective: To identify the viewpoints and perceptions of different stakeholders regarding high cost medicines (HCMs). Methods: A systematic review of the literature was performed to identify original research articles. Using predefined categories, data related to the viewpoints of different stakeholders was systematically extracted and analyzed. Results: Thirty seven original research articles matched the criteria. The main stakeholders identified include physicians, patients, public and health funding authorities. The influence of media and other economic and ethical issues were also identified in the literature. A large number of stakeholders were concerned about lack of access to HCMs. Physicians have difficulty balancing the the rational use of expensive drugs while at the same time acting as “patients’ advocate”. Patients would like to know about all treatment options, even if they may not be able to afford them. The process and criteria for reimbursement should be transparent and access has to be equitable across patient groups. Conclusion: Access to HCMs could be improved through transparency and involvement of all stakeholders, especially patients and the public. Moral issues and the “rule of rescue” could influence decision-making process significantly. At system level, objectivity is important to ensure that the system is equitable and transparent.
Chronic fatigue syndrome (CFS) is characterized by unexplained fatigue lasting for more than 6 months and accompanied by flulike symptoms. It most commonly affects women aged between 30 and 60 years. To date, clear diagnostic criteria allowing for unambiguous diagno-sis of CFS have not been established. We present a case of a 57-year-old woman with chronic fatigue syndrome in order to showcase the symptoms of this condition and propose a diagnos-tic protocol.
ObjectiveThe therapeutic potential of simvastatin as an anti-inflammatory agent was explored by investigating its effect on the lipopolysaccharide (LPS)-induced inflammatory response in rat pulmonary microvascular endothelial cells (RPMVECs).MethodsRPMVECs were isolated and the mRNA and protein levels of different toll-like receptors (TLR) were assessed by qRT-PCR and western blotting. The LPS-induced expressions of TLR4, TNF-α and iNOS were analyzed in RPMVECs treated with different concentrations of simvastatin for different times. NF-κB activation was examined by immuofluroscence, luciferase reporter assay and western blotting.ResultsTLR4 is abundantly expressed in RPMVECs, and its expression is induced by LPS stimulation. Simvastatin inhibited LPS-induced TLR4 expression at the mRNA and protein levels in a time-dependent manner (p<0.01), and alleviated inflammation in RPMVECs by inhibiting the release of inflammatory factors such as TNF-α and iNOS. Further study indicated that simvastatin significantly attenuated NF-κB activity by inhibiting the degradation of IκB-α. Pretreatment with pyrrolidine dithiocarbamate (PDTC) and knock-down of TLR4 expression by RNA interference down-regulated the LPS-induced inflammatory response in RPMVECs.ConclusionSimvastatin inhibits the LPS-induced inflammatory response in RPMVECs by down-regulating TLR4 expression, suggesting its role as a potential inhibitor of LPS-induced inflammation
Multiple ring enhancing lesions (MREL) in the brain can be caused by a variety of diseases including infections, inflammatory and neoplastic conditions. We present the case of a patient with new onset unilateral jerking movement of the arm who was found to have sixteen ring enhancing lesions (RELs) in the brain on MRI. Further workup revealed a primary small cell lung cancer. The differential diagnosis of multiple ring enhancing lesions is discussed. The astute clinician should be aware of this rare but important radiological finding.
To investigate the adverse reactions of transcatheter arterial chemoembolization (TACE) combined with trastuzumab in the treatment of unresectable live cancer, 85 unresectable liver cancer patients were treated with 35 mg epirubicin, with lipiodol and gelatin sponge granule as the embolic agent, and trastuzumab (4mg/kg) was administered intravenously. All the adverse reactions were investigated by blood routine examination and the checking of liver, renal and thyroid functions on the postoperative 2nd and 30th day. No patients died of direct medication. The main adverse reactions included haematological toxicity, liver function lesion and postoperative syndromes such as nausea, vomiting, fever and liver area aching. Two days after the treatment, the amount of the serum total bilirubin (TB) and white blood cell (WBC) increased dramatically, while platelet (PLT) changed a little, and creatinine (Cr) and blood urea nitrogen (BUN) did not change at all. Thirty days after the treatment, blood routine, liver and renal functions were examined, demonstrating that the liver function remained unchanged, PLT decreased apparently, WBC was lower, and Cr and BUN changed slightly compared to those before the treatment. The combined treatment is safe for unresectable liver cancer and thus can be used as a routine intervention method.
To investigate the mechanism in Scutellarein-induced apoptosis of SAS human tongue cancer cells, inhibitory effects of Scutellarein on SAS cells were detected by MTT assay. Cell apoptosis was analyzed by flow cytometry. Ultrastructural changes of SAS cells were observed by transmission electron microscopy (TEM). Mitochondrial transmembrane potential (ΔΨm) were analyzed by JC-1 [5,5,6,6-Tetrachloro-1,1,3,3-tetraethylbenzimidazolylcarbocyanine iodide]. Western blotting was used to examine the expression level of Bcl-2, Bax and caspase-3 in SAS cells treated with Scutellarein. Scutellarein inhibited the proliferation of SAS cells in a time and dose-dependent manner and increased the percent of apoptotic cells. The mitochondrial cristae were swollen and had vacuolar degeneration. ΔΨm decreased when the concentration of scutellarein increased. Scutellarein effectively up-regulated the expression of mitochondrial Bax and caspase-3 and down-regulated the expression of Bcl-2. Scutellarein induces apoptosis of SAS human tongue cancer cells via activating mitochondrial signaling pathway.
Objective The aim of this study was to examine the expression patterns of CEACAM5 in prostatic non-neoplastic and neoplastic lesions and further investigate its relationship with tumor microvessel density(MVD) and lymphatic vessel density(LVD). Methods CEACAM5 expression was detected using immunohistochemical staining in a serial sections of the benign prostatic hyperplasia (BPH), prostate intraepithelial neoplasia (PIN) and prostate carcinoma (PCa) lesions. MVD and LVD were quantified in CEACAM5 positive areas by dual-labelling with CD34 and D2-40 respectively. Results Both PIN and PCa had significantly higher expression for CEACAM5 than BPH which has no positive expression for CEACAM5(P<0.05). In PIN and PCa, CEACAM5 staining showed different expression patterns in terms the of most of membranous staining for PIN, less membranous staining and more cytoplasmic staining for PCa. MVD results showed that PCa and PIN had more angiogenesis than BPH tissue. The value of MVD in PCa tissue was correlated with tumor Gleason grading (P<0.05). LVD results showed that neoplastic lesions had more lymphangiogenesis than non-neoplastic lesion. Conclusion CEACAM5 had different expression patterns in prostatic non-neoplastic and neoplastic lesions, and these various expression patterns may be correlated with tumor progression through promoting tumorous angiogenesis or lymphangiogenesis.
We have described a rare case of Takotsubo cardiomyopathy in pregnancy, which is presented with cardiac arrest (ventricular fibrillation) at onset. In this case, the transient left ventricular ballooning in absence of coronary artery disease, produced a severe impairment of cardiac function with typical echocardiographic and electrocardiographic findings. There were complications in the form of ventricular fibrillation, with recurrence due to possible Takotsubo cardiomyopathy and new malignant heart rhythm disorder that increases the mortality rate compared with the first attack of Takotsubo cardiomyopathy. Due to presented symptoms the patient has opted for the implantation of cardioverter defibrillator.
The simultaneous application of intravenous fat emulsion and charcoal hemoperfusion in the case of severe quetiapine poisoning is described. The initial blood concentration of quetiapine was 5.9 µg/mL and rapid deterioration in the patient status was observed. When a lipid emulsion was infused a fast blood pressure recovery occurred which allows to perform extracorporeal clearance using charcoal hemoperfusion. At the end of the procedure the quetiapine concentration was decreased down to 1.5 µg//mL and fast recovery of the patient was observed.
The article focuses on the eruption of palmoplantar pustular psoriasis, which was documented in a 53-year-old man diagnosed with prostate cancer with bone metastases. This clinical finding was made during routine hormone therapy and palliative radiotherapy. The local improvement in skin lesions was achieved following administration of topical ointments and the use of UVA 311 nm radiation therapy. The management of prostate cancer in this subject resulted in malaise, onset of diabetes mellitus and increased concentration of serum lipids. Interestingly, a few days after the statin treatment was initiated, the intensive pustule eruption was observed as well as severe pain and burning sensation in the palms and soles. The dermatological treatment led to significant improvement. The patient is still receiving oncological therapy and is monitored by dermatologists on a regular basis.
In the present study, we investigated the relation between clinical parameters and levels of interleukin (IL) -4 and -5, and tumour necrosis factor-α (TNF-α) in the leukocyte incubation medium (LIM) obtained from 26 patients with chronic periodontitis (P) and 26 control group subjects (C). The levels of cytokines IL-4 and IL -5 produced by the LIM stimulated with non-opsonised E. coli were determined using the Enzyme-Linked Immunosorbent Assay (ELISA) method and the levels of TNF-α were evaluated by applying Enzyme Amplified Sensitivity Immunoassay (EASIA). TNF-α levels in stimulated LIM were strongly positively correlated with clinical parameters such as the pocket probing depths (PPD), the clinical attachment level (CAL), the bleeding on probing (BOP) and oral hygiene index (OHI), whereas the IL-4 and IL-5 levels in the analogous medium were strongly negatively correlated with the clinical parameters. IL-4 and IL-5 levels in stimulated LIM of P group patients were significantly lower, whereas TNF-α levels were significantly higher than that in analogous medium of C group subjects. These differences were associated with the severity of periodontal disease.
BackgroundThe electrocardiogram (ECG) is a diagnostic test commonly used in daily Primary Care practice. General Practitioners (GP) often feel unsure about their interpretation of ECGs, so they engage external services to provide it.AimTo evaluate accuracy of ECG readings done by GPs by comparison with those done by a cardiologist as the gold standard.MethodsWe studied 195 ECGs collected consecutively during first semester of 2010 in an urban Health Centre of Portugal. Each ECG was read by each physician and inter-observer agreement was evaluated. After coding by Novacode, sensitivity and specificity of GP’s readings were calculated.ResultsInter-observer agreement between GP readings was “good” with an intraclass correlation coefficient of 0.727 (CI 95%: 0.670–0.779). When compared with gold standard, GP achieved a “good” agreement with an intraclass correlation coefficient of 0.712 (CI 95%: 0.659–0.762). The overall accuracy of GP for detecting abnormalities was 81.0% (95%CI: 75.7–85.6%), with a sensitivity of 84.8% (95%CI: 77.3–90.6%) and a specificity of 77.5% (95%CI: 69.7–84.2%). For normal tests, accuracy was 79.9% (95%CI: 74.7–84.3). In the most prevalent classes of abnormalities, accuracy was higher than 90%.ConclusionGP showed good skills in reading ECGs in their practice of Primary Care. Better attention should be given to ischemic abnormalities present on ECGs. Key message: General Practitioners demonstrate good skills for reading the ECGs of patients on a primary care centre when compared to the gold standard defined by a cardiologist reading.
